Health Care Associated Infections in Cuban Patients at Institute ¨Pedro Kourí¨: Risk, Causes and Public Health Impact
Lilia María Ortega González1*, Odalys Marrero Martínez1, Milena Duque Vizcaino1 and Denis Verdasquera Corcho2
1Department of Medical Attention, Hospital, Institute “Pedro Kourí”, Havana, Cuba
2 National School of public Health, Havana, Cuba
Submission: September 14, 2019; Published: October 16, 2019
*Corresponding author: Lilia María Ortega González, Department of Medical Attention, Hospital, Institute “Pedro Kourí”, Havana, Cuba
How to cite this article:Lilia María Ortega González. Health Care Associated Infections in Cuban Patients at Institute ¨Pedro Kourí¨: Risk, Causes and Public Health Impact. JOJ Pub Health. 2019; 5(2): 555658. DOI: 10.19080/JOJPH.2019.05.555658
Abstract
A cross-sectional study was designed with a statistical universe of 241 patients admitted to the hospital for a period longer than 48 hours. 79.7% of the patients were HIV / AIDS; the prevalence rate of Health care associated infections (HCAIs) was 30.7%, with hospital-acquired pneumonia (38.4%) and laboratory-confirmed bloodstream infections (28.2%) as the most frequent. The predominant microbiological isolates were: K. pneumoniae (17.5%), S. aureus (17.5%), P. aeruginosa (14.3%) and E. Coli (12.7%). There was a significant relationship between risk factors such as: previous hospitalization, use of invasive devices and previous use of antibiotics with the presence of HCAIs.
Keywords:Health care-associated infections; Risk factors
Abbreviations: HCAIs: Healthcare Associated Infections; CLABSI: Central Line-Associated Blood Stream Infection; LCBI: Laboratory Confirmed Bloodstream Infection; BSI: Secondary Bloodstream Infection; Catheter-Associated, UTI: Urinary Tract Infection; HAP: Hospital-Acquired Pneumonia
Introduction
HCAIs represent a serious worldwide health problem. They are among the main causes of morbidity and mortality only preceded by cardiovascular diseases [1,2]. The World Health Organization (WHO) estimates that more than 1.4 million people in the world get infections in hospital environments [3]. Prevalence of HCAIs range between 6 and 13%, according to the characteristics of the clinical institution, with intensive care units (ICU) reporting the highest number of cases. Developed countries report an incidence of HCAIs between 5% and 10%, while developing countries have shown rates between two and twenty times higher than those of developed countries [2,4,5].
The importance of this phenomenon currently associated with infections by multidrug-resistant microorganisms, led to the establishment of surveillance programs, which have allowed the identification of a progressive increase in multiple antibiotic resistance in gram-negative bacilli, especially in enterobacteria [5-18]. Current studies have demonstrated the importance of performing effective infection control programs, which would lead to a significant decrease in HCAIs (32%), with repercussion on morbidity, mortality and monetary burden [14-32]. Studies targeting HCAIs in Cuba are very scarce, the HIV / AIDS population in particular lacks comprehensive analyses of these diseases. In our current study, our goal is to determine prevalence rate of HCAIs as well as to identify risk factors associated with these diseases, with the ultimate goal of improving the quality of medical care for these patients and establishing surveillance and control strategies of HCAIs.
Materials and Methods
A cross-sectional study was conducted. The experimental universe consisted of 241 patients admitted to the hospital for a period greater than 48 hours, during the months of January to June 2018. Subsequently, the risk factors of patients who developed HCAIs during admission were analyzed. The diagnosis of HCAIs was reached considering the criteria established by the Centers for Diseases Control and Prevention (CDC). The information was obtained from medical records of the patients; in addition, the microbiological results were collected according to isolation performed by the microbiology laboratory. Absolute and relative frequencies were calculated. To determine the association between the different risk factors and the presence of the disease or condition under study, the Odds Ratio was calculated with their respective confidence intervals, with a 95% reliability value. It was considered that there was an association when the value of the Odds Ratio was greater than 1. The value of p was also calculated considering significance when it was less than or equal to 0.05.
Results
79.7% of patients included in this study were HIV/AIDS positive, with 50.3% showing plasma viral loads at admission to the institution of less than 50,000 cps/ml and 71.8% CD4+ T cell counts of less than 200 cells/ mm3.The prevalence rate of patients infected with an HCAIs was 30.7%. More than one infection site was detected in 5.4% of cases with an infection prevalence rate of 32.4%. 93.2% of the patients with HCAIs were HIV / AIDS. The fundamental site of HCAIs was hospital acquired pneumonia (38.4%) (Table 1) Microbiological isolations were generated in 80.76% of cases. The remaining 19.24% were diagnosed by clinic methods according to the CDC’s criteria for the diagnosis of HCAIs. The most commonly identified germs were Staphylococcus aureus (17.5%), Klebsiella pneumoniae (17.5%), Pseudomona aeruginosa (14.3%) E. coli (12.70%). The highest frequency of isolation was found in patients with hospital-acquired pneumonia (CAP) with Gram-negative germs (Klebsiella pneumoniae, Pseudomona aeruginosa and Escherichia coli) followed by laboratory-confirmed bloodstream infections (LCBIs), caused by S.aureus (Figure 1).
We identified the use of invasive devices as a key extrinsic risk factor for developing HCAIs. A big majority of patients had some sort of invasive device during their hospital stay, 58.5% of them had a peripheral venous catheter, 19.5% a central venous catheter, 13.7 % a bladder catheter, 7.5 % a hemodialysis catheter and 2.1% a pleural tube. A causal association was demonstrated between all the risk factors analyzed, with the use of invasive devices being the most commonly associated. Patients requiring devices were 31.19 times more likely to develop an HCAIs, (95% confidence interval [CI] 21, 04 - 45, 08) (Table 2).
Discussion
HCAIs are a major cause of morbidity and mortality in hospitalized patients, with the prevalence of hospitalized patients dependent on multiple factors such as hospital characteristics and number of beds. The IPK includes a hospital specialized in the management of infectious diseases and is a reference hospital for the care of HIV/AIDS patients, which means a high percent of its patients coming from an immunocompromised population, and as a result showing increased risk of HCAIs. In this study we find high prevalence rates compared to those previously reported worldwide. Particularities of these results can be partially explained by the characteristics of patients treated at this institution, who are mostly HIV/AIDS patients with a marked impairment of their immune system and exposed to a wide range of medical devices used for complex treatments of opportunistic diseases.
Respiratory system infections were common in our study, these are common in HIV patients due to the typical depression of the immune system; on the other hand we had a significantly increased incidence of bloodstream infection events that we hypothesized was related to exposure to multiple risk factors, with the use of vascular accesses and prolonged pharmacological treatments as the main potential risk factors together with the severe immunosuppression characteristic of the cases studied [1-6,8- 16,32]. The low rates found of urinary tract infections (UTIs) may be related to their under-registration due to insufficient indication of microbiological studies for detection. This study showed association between all risk factors analyzed and HCAIs, with the use of invasive devices showing relevance, this is equivalent to previously reported studies [6, 8,16-28].
HCAIs are currently considered to be the most common adverse event in hospitalized patients; there are numerous risks factors potentially leading to HCAIs, including: decreased classical immunity in HIV/AIDS patients; invasive medical procedures and the indiscriminate use of antibiotics. These diseases can be avoided by complying with good clinical practices and appropriate surveillance and control programs [29-40].
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